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HEALTH OF ABORIGINAL AND TORRES STRAIT ISLANDER AUSTRALIANS

The 2004-05 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS), conducted by the Australian Bureau of Statistics (ABS), provides information about the health circumstances of Indigenous Australians. The survey collected information from 10,400 Indigenous people in private dwellings across all states and territories of Australia, including those living in remote areas, and built on the Indigenous supplements to the 1995 and 2001 National Health Surveys (NHS(I)). It is planned to repeat the survey at six-yearly intervals as part of a cycle of Indigenous household surveys, and to coincide with every second National Health Survey (NHS). Together with the National Aboriginal and Torres Strait Islander Social Survey (NATSISS), the NATSIHS provides a wide range of information about the wellbeing, social circumstances and outcomes of Aboriginal and Torres Strait Islander peoples.

This article presents a selection of results from the 2004-05 NATSIHS, measures of selected changes since the 2001 NHS(I)), and comparable results for the non-Indigenous population from the 2004-05 National Health Survey (NHS). Some information from the 2002 NATSISS is also included.

POPULATION
Aboriginal and Torres Strait Islander peoples comprise 2.4% of the total Australian population. During the collection phase for the 2004-05 NATSIHS, the Indigenous population in private dwellings was projected to be 474,300.

The Indigenous population is relatively young, with a median age of 21 years compared with 36 years for the non-Indigenous population. As age is closely associated with health, care should be taken when comparing information for these two populations. To account for differences in the age structure, comparisons between Indigenous and non-Indigenous people are presented by age group or as rate ratios based on age-standardised data, as appropriate. More information on the size, age structure and distribution of the Indigenous population, is provided in the Aboriginal and Torres Strait Islander populationin the Populationchapter.

HEALTH STATUS

Self-assessed health

Self-assessed health status provides an indicator of overall health; it reflects an individual's perception of his or her own health. This measure is dependent on an individual's awareness and expectations regarding their health, and may be influenced by factors such as access to health services and health information.

In 2004-05, just over three-quarters (78%) of the Indigenous population reported their health as either good, very good or excellent, consistent with 77% reported in the 2002 NATSISS. The remaining 22% of Indigenous people reported their health as fair or poor.

Self-assessed health varies with age. The proportion of people aged 15-24 years reporting excellent or very good health was 59%, compared with 18% of people aged 55 years and over (graph 9.18).

After adjusting for differences in age structure between the Indigenous and non-Indigenous populations, Indigenous people overall were almost twice as likely as non-Indigenous people to report their health as fair or poor - a relative difference which was apparent across most broad age groups.

Social and emotional wellbeing

The 2004-05 NATSIHS collected, for the first time, information on the social and emotional wellbeing of Indigenous adults (aged 18 years and over) using selected questions from the SF-36 (measuring generic health status in the community) and the Kessler Psychological Distress Scale. Questions were also asked about feelings of anger, the impact of psychological distress, stressors, and cultural identification.

In response to questions (from the SF-36) about feelings of happiness and energy levels, more than half the adult Indigenous population reported feeling happy (71%), calm and peaceful (56%), and/or full of life (55%) all or most of the time, while just under half (47%) said they had a lot of energy all or most of the time. Indigenous people in remote areas were more likely to report having had these positive feelings all or most of the time, than were Indigenous people living in non-remote areas - a difference of at least five percentage points for each measure.

In response to questions from the Kessler Psychological Distress Scale, 9% of Indigenous adults reported feeling nervous all or most of the time. When asked how often they felt without hope, 7% reported having had this feeling all or most of the time. Similarly, 7% said that they felt so sad that nothing could cheer them up, all or most of the time. Around one in six Indigenous adults (17%) reported that everything was an effort all or most of the time and 12% felt restless all or most of the time.

Long-term health conditions and disability

In 2004-05, around two-thirds (65%) of Indigenous people reported at least one long-term health condition; with a higher proportion in non-remote areas (68%) than remote areas (57%). One in seven Indigenous people (14%) reported two long-term health conditions and a further 29% reported three or more. After adjusting for age differences between the two populations, Indigenous and non-Indigenous Australians were equally likely to report a long-term health condition.

(a) A medical condition (illness, injury or disability) which has lasted at least six months, or which the respondent expects to last for six months or more. This is an ICD-10 based output classification.(b) Age-standardised Indigenous rate divided by age-standardised non-Indigenous rate, except for ear/hearing problems.(c) Difference between 2001 and 2004-05 data is statistically significant.(d) Indigenous to non-Indigenous rate ratio for ear/hearing problems is based on actual rates, not age-standardised rates.(e) Sum of components may exceed total as persons may have reported more than one long-term health condition.

Asthma was reported by 15% of Indigenous Australians in 2004-05 - almost twice as often in non-remote areas (17%) as in remote areas (9%). Within the Indigenous population, asthma was more prevalent among females than males in all age groups apart from children aged 0-14 years (graph 9.20).

After adjusting for age differences between the Indigenous and non-Indigenous populations, Indigenous people were 1.6 times more likely to report asthma as a long-term health condition than non-Indigenous people (table 9.19).

Heart and circulatory problems/diseases

Consistent with results from the 2001 survey, 12% of Indigenous Australians reported a long-term health condition associated with the circulatory system, such as heart disease or hypertensive disease. In 2004-05, these long-term conditions were more prevalent in remote (14%) than non-remote (11%) areas. Rates of heart and circulatory problems/diseases were higher for Indigenous females than for males in all broad age groups.

Heart and circulatory diseases/problems tend to develop over the course of a lifetime. Results from the 2004-05 NATSIHS show a marked increase in the prevalence of these conditions among Indigenous people from around 35 years of age onwards. After adjusting for age differences between the Indigenous and non-Indigenous populations, Indigenous people were 1.3 times more likely than non-Indigenous people to report heart disease and/or circulatory problems (table 9.19).

Diabetes

Diabetes (including high sugar levels) continues to be a significant health issue among Indigenous Australians, with an overall prevalence of 6% in 2004-05. Consistent with results from 2001, diabetes was almost twice as prevalent among Indigenous people in remote areas (9%) as it was in non-remote areas (5%). Within the Indigenous population, diabetes was more prevalent among females than males, particularly among those in the 35-54 year age group (graph 9.21).

After adjusting for age differences between the Indigenous and non-Indigenous populations, Indigenous people were more than three times as likely as non-Indigenous people to report some form of diabetes (table 9.19).

Kidney disease

In 2004-05, kidney disease was reported by 2% of Indigenous people overall (3% in remote areas and 1% in non-remote areas). Kidney disease increased with age, from less than 1% of Indigenous children aged 0-14 years to 7% of Indigenous Australians aged 55 years and over. After adjusting for age differences, rates of kidney disease were about 10 times higher in the Indigenous population than in the non-Indigenous population (table 9.19). The treatment of kidney disease accounts for around one-third of all hospital admissions of Indigenous people.2

The 2004-05 NATSIHS collected information from private dwellings only (i.e. not from health-care facilities) and may, therefore, have underestimated the prevalence of kidney disease in the Indigenous population.

Disability

The 2002 NATSISS provided, for the first time, information on the prevalence of disability among Indigenous Australians aged 15 years and over. Data for Indigenous people aged 18 years and over in non-remote areas is comparable with results for non-Indigenous adults from the 2002 General Social Survey, conducted by the ABS.

In 2002, over one-third (36%) of Indigenous people aged 15 years or over had a disability or long-term health condition which limited their ability to perform everyday activities. Overall rates of disability were similar for males and females; rising from 23% of those aged 15-24 years to 70% of those aged 55 years and over.

Among Indigenous people with a functional limitation, 8% had a profound or severe core activity limitation, meaning that they always or sometimes needed assistance with at least one activity of everyday living (self-care, mobility or communication).

In non-remote areas, after adjusting for age differences between the two populations, Indigenous adults were much more likely than non-Indigenous adults to have a profound or severe core activity limitation, regardless of age (graph 9.22). The earlier onset of long-term health conditions and/or disability, and consequent need for assistance, means that Indigenous people have a comparatively higher need for service provision at relatively younger ages.

HEALTH-RELATED ACTIONS

An individual's health-related actions, and access to health professionals and services are important factors in the successful prevention and management of health conditions. Apart from visits to a dentist, Indigenous people were more likely than non-Indigenous people to have taken at least one of the surveyed health-related actions in 2004-05 (table 9.23).

(a) Hospital admissions relate to the twelve months prior to interview. All other health-related actions relate to the two weeks prior to interview.(b) Age-standardised Indigenous rate divided by age-standardised non-Indigenous rate.(c) Persons aged two years and over.(d) Persons aged 5-64 years.(e) Persons aged five years and over.

In 2004-05, half the adult Indigenous population (50%) reported smoking one or more cigarettes per day. Smoking was more prevalent among Indigenous than non-Indigenous adults in every age group (graph 9.24). After adjusting for age differences between the two populations, Indigenous adults were more than twice as likely as non-Indigenous adults to be current daily smokers.

Alcohol consumption

In 2004-05, around half of all Indigenous adults (49%) reported having consumed alcohol in the week prior to interview, of whom one-third (16%) reported drinking at risky/high risk levels. When compared with results from 2001, the proportion of Indigenous adults who reported drinking at risky/high risk levels in 2004-05 was about three percentage points higher overall (five points higher in non-remote areas and two points lower in remote areas). After adjusting for differences between the age-structure of the Indigenous and non-Indigenous populations, Indigenous adults were less likely than non-Indigenous adults to have consumed alcohol in the preceding week (45% compared with 63%), although the proportions who reported drinking at risky/high risk levels were similar (15% compared with 14%).
Diet and exercise

Many of the principal causes of ill-health among Aboriginal and Torres Strait Islander people are nutrition-related diseases, such as heart disease, Type II diabetes and renal disease. While a diet high in saturated fats and refined carbohydrates increases the likelihood of developing these diseases, regular exercise and intake of fibre-rich foods, such as fruit and vegetables, can have a protective effect against disease.

In 2004-05, the majority of Indigenous Australians aged twelve years and over reported eating at least one serve of vegetables (95%) and/or fruit (86%) each day. In addition, 79% usually drank whole milk and 11% drank low/reduced fat milk. Indigenous people in non-remote areas were more likely to drink whole milk than were non-Indigenous people, regardless of age.

Information relating to the frequency, intensity and duration of exercise undertaken by Indigenous Australians living in non-remote areas showed that the proportion who were sedentary or engaged in low level exercise in the two weeks prior to interview was higher in 2004-05 (75%) than in 2001 (68%).

Body mass

In the 2004-05 NATSIHS and NHS, self-reported height and weight measurements were collected for people aged 15 years and over. Using Body Mass Index (End note 1) scores, just under one-third (31%) of Indigenous people were recorded as being in the normal or healthy weight range, with a further 23% in the overweight category and 24% classified as obese. After adjusting for non-response, and age differences between the two populations, Indigenous Australians were 1.2 times more likely to be overweight/obese than non-Indigenous Australians. In each age group the disparity between Indigenous and non-Indigenous people was greater for females than for males.

Breast-feeding

In 2004-05, the majority of Indigenous women aged 18-64 years with children, reported having breast-fed them (84%), consistent with results from 2001 (86%). The proportion of women who breast-fed their children was higher in remote areas (92%) than non-remote areas (80%). Similarly, 79% of Indigenous children under four years of age had been breast-fed for at least some period, of which 13% were being breast-fed at the time of the 2004-05 survey.

The data presented in this article represent only some of the insights that can be obtained from the 2004-05 NATSIHS. Other health-related topics include child and adult immunisation, substance use and women's health (including contraception). In addition, the survey also collected a range of socio-economic information which can be used to provide a broader context for the range of health indicators. Readers interested in undertaking further analysis of the data are referred to the National Aboriginal and Torres Strait Islander Health Survey: Users' Guide, 2004-05 (4715.0.55.004).

END NOTE

1Body Mass Index (BMI) scores are calculated from reported height and weight information, using the formula: weight in kilograms divided by the height in metres squared. BMI values are grouped as follows: Underweight (less than 18.5); Normal weight (18.5 to less than 25.0); Overweight (25.0 to less than 30.0) and Obese (30.0 or higher).

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